"What's frightening about this emerging street drug is that users themselves may not be aware that they are ingesting it," said lead study author John Stogner, Ph.D. of the Department of Criminal Justice and Criminology at the University of North Carolina at Charlotte, N.C. "A patient may report heroin use and have symptoms consistent with heroin overdose, but an emergency physician may find that the standard dose of antidote (naloxone) doesn't work. Larger or additional doses are necessary when acetyl fentanyl is responsible. It's never good to lose time between overdose and treatment."
Acetyl fentanyl is an analogue of medical fentanyl but is not regulated in the same way. If acetyl fentanyl is packaged in a particular way, with a label stating "not for human consumption," the product is technically legal, thus allowing the drug to float in a legal gray area. The drug is illegal when packaged for human consumption, but legal when packaged otherwise and drug companies can exploit such a loophole.
"Clever and well-informed drug distribution networks will likely take advantage of the legal loophole and profit by replacing or cutting a highly-regulated drug with this less regulated one," said Dr. Stogner. "One of the many downsides of illegal drugs is you just can't trust your drug dealer. The trend of adulterants being worked into street drugs to make them more potent is dangerous. The significant potential for overdose of acetyl fentanyl necessitates more medical research and policy reform."
The drug is detailed online in the Annals of Emergency Medicine.